Pilonidal Disease

• • Acute, chronic, recurring abscess or chronic draining sinus over the sacrococcygeal or perianal region

  • An acquired infection of natal cleft hair follicles that become distended and obstructed and rupture into the subcutaneous tissues to form a pilonidal abscess

  • Hair from the surrounding skin is pulled into the abscess cavity by the friction generated by the gluteal muscles during walking

Epidemiology

• • Incidence of pilonidal disease is highest in white males (3:1 male:female ratio) between ages 15 and 40 with a peak incidence between 16 and 20 years

  • Most common in the hirsute, moderately obese patient

Symptoms and Signs

• • Pain, fluctuant mass

  • Tenderness

  • Purulent drainage

  • Inspissated hair

  • Induration

  • Patients may present with small midline pits or abscesses on or off the midline near the coccyx or sacrum

  • Physical exam may reveal a spectrum of disease from acute suppuration and an undrained abscess or chronic draining sinuses with multiple mature tracts with hairs protruding from the pit-like openings

  • Most sinus tracts run cephalad

Laboratory Findings

• • No specific findings

• • Cryptoglandular abscess

  • Fistula-in-ano

  • Hidradenitis suppurativa

  • Furuncle

  • Actinomycosis

  • Tuberculous granuloma

  • Osteomyelitis with draining sinuses

• • History and physical exam

Surgery

• • Pilonidal abscesses may be drained under local anesthesia

  • Probe may be inserted into the primary opening and the abscess unroofed

  • Granulation tissue and inspissated hair are pulled out

  • Excision of midline pits with removal of hair from lateral tract

  • Excision with open packing, marsupialization, or primary closure with or without flaps

Medications

• • Antibiotics usually not indicated

Complications

• • Untreated pilonidal disease may result in multiple draining sinuses with chronic recurrent abscess, drainage, soiling of clothing, and, rarely, necrotizing wound infections or malignant degeneration

  • Carcinoma arising from chronic pilonidal sinus is rare, usually well-differentiated squamous cell carcinoma

  • -Treatment is wide excision

Prognosis

• • Cure rates of 60-80% have been reported after primary unroofing and extraction of hair

  • Conservative excision of midline pits with removal of hair from lateral tracts and postoperative weekly shaving has 90% success rate

Prevention

• • Meticulous skin care (shaving of natal cleft)

  • Perineal hygiene, wound cleansing

References